RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03987
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060910

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Multichannel Transmission Systems Operator, medically separated for “reflex sympathetic dystrophy right leg,” with a disability rating of 10%.

CI CONTENTION:  The CI requests consideration of all conditions.  The CI’s complete submission is at Exhibit A. 

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is based upon a review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20060802	VARD - 20070807	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Reflex Sympathetic Dystrophy, Right Leg	8799-8723	10%	Right Superficial Peroneal Neuropathy and Right Foot Reduced Sensation	8599-8521	10%	20070116	
Adjustment Disorder	Not Unfitting	Psychosis Including Anxiety and Depression	9299-9210	30%	20070117	
RATING:  10%	COMBINED RATING:  40%	

ANALYSIS SUMMARY:  

Reflex Sympathetic Dystrophy, Right Leg.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s reflex sympathetic dystrophy, right leg condition began in June 2005 after attempted repair of right lateral leg pain and muscle herniation in the right lateral position.  In the immediate postoperative period, there seemed to be improvement in pain but over 3-4 months afterwards, there was tremendous paresthesia and numbness of the top of the foot as well as hyperesthesia of the skin of the top and lateral right leg.  Physical therapy and treatment with narcotic and other pain medications provided little improvement in the past year.  The MEB forwarded reflex sympathetic dystrophy, right leg for PEB adjudication.  

At the MEB examination dated April 2006, 4 months prior to separation, the CI reported numbness and tingling of the right foot/ankle that increased with running (note able to do), climbing stairs and getting out of cars.  He reported new tears to the right of the previous muscle herniation in October 2005.  Bone scan showed a possible os trigonium syndrome (pain in the back of the ankle) of left ankle with stress/post traumatic changes at the right first metatarsal bone and left ankle.  Nerve conduction studies showed mildly delayed right peroneal nerve conduction latency at the ankle and right tibial nerve conduction mildly delayed at the ankle.  Nerve conduction study in April 2006 was consistent with a demyelinating neuropathy affecting the right superficial peroneal nerve.  He was taking medication for pain, including a narcotic and a seizure medication.  Physical examination showed muscle herniation of the lateral aspect of the proximal scar, decreased sensation to touch of the right anterior leg, hypersensitivity to touch of the right ankle, right lower leg and right dorsal aspect of the foot, tenderness along the distal incision and right foot.  Pain was elicited by dorsiflexion and inversion.  The active range of motion (ROM) was limited.  He was limping and unable to perform toe or heel walk.  There were two surgical scars on the right lower leg.  

The MEB NARSUM examination on19 June 2006, 3 months prior to separation, noted complaints of pain at a level that prevented him from wearing heavy clothing over the extremity, including standard Army boots.  He had to wear light footwear and was unable to stand for more than 15-20 minutes and had significant difficulty with running or fast walking.  Musculoskeletal examination of the right lower extremity was notable for 2 transverse surgical scars in the lateral aspect of the lower extremity above the ankle.  There was hypesthesia of the lateral aspect of the leg, dorsum and sole of the foot, mild numbness on the medial aspect of the ankle.  Pulses in the lower extremity were normal and symmetrical bilaterally.  He walked with a limp, and appeared unable to completely dorsiflex the right ankle.  Plantar flexion was about 40 degrees with inversion of 30 degrees.  The AMA pain rating was moderate/constant.  Capillary reflex was normal.  

At the 16 January 2007 VA Compensation and Pension (C&P) evaluation, performed 4 months after separation, the CI reported constant pain in the right leg, radiating to the right foot,  for the past 3 years.  Pain level was 7/10 and could be elicited by activity or by itself.  It was relieved by rest.  He could function without medication if he had pain.  He was not receiving any treatment.  Prolonged standing and walking was limited.  Physical examination showed normal gait and no assistive devices.  Examination of the right tibia and fibula were normal.  The right ankle showed no swelling, fluids, weakness, tenderness, redness, heat, abnormal movement, subluxation or guarding of movement.  ROM of the right and left ankle joint showed dorsiflexion to 20 degrees and plantar flexion to 45 degrees.  Joint function was limited on the right by repetitive use: pain, fatigue, lack of endurance the most functional impact.  The preceding limited joint function by 5 degrees in dorsiflexion.  Neurological examination showed abnormal sensory function with reduced sensation in dorsolateral right distal leg and foot in the superficial peroneal nerve distribution.  Reflexes were normal and equal to left lower extremity reflexes.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the reflex sympathetic dystrophy, condition 10%, coded analogously to 8799-8723 (neuralgia, anterior tibial nerve (deep peroneal), citing moderate incomplete paralysis of the right leg.  The VA also  rated the right superficial peroneal neuropathy and right foot reduced sensation condition 10% code 8599-8521 (incomplete paralysis of common peroneal nerve, mild), based on the VA C&P examination 4 months after separation, citing mild incomplete paralysis of foot movements.  Board members agreed the injury was of moderate disability and there was no evidence to support a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the reflex sympathetic dystrophy condition.  

Contended PEB Conditions: Adjustment Disorder.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  Adjustment disorder is not a condition constituting a disability that is subject to service disability compensation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the reflex sympathetic dystrophy disorder condition and IAW VASRD §4.124, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the adjustment disorder condition and IAW VASRD §4.130, the Board recommends no change in the PEB adjudication. There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140723, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

30 NOV 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160017703 (PD201403987)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation and hereby deny the individual’s application. This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA